Multidisciplinary Approach

The Lap Band -

Adjustable Gastric Banding

The Lap Band is a mechanical device that is placed around the uppermost part of the stomach in order to form a small “pseudo-pouch” which fills with ingested food. The outlet from the pouch is restricted by the inflatable portion of the band and can be adjusted to slow the emptying of food. This readily allows for the creation and maintenance of the feeling of fullness.

The Lap Band was developed over a ten year period beginning in the 1980s. The first Lap Band was placed in Europe around 1992, and has been extensively used since then--especially in Europe and Australia. The Lap Band received FDA approval in the Summer of 2001 after a U.S. trial. Dr. Scott and Dr. de la Torre were part of a select few bariatric surgeons involved in this investigation. Because of this, their experience with the Lap Band dates back to 1999.

Like other purely restrictive procedures, the effect from the Lap Band occurs from a decrease in the amount of food (and calories) that is eaten at a given setting. The sensation of fullness occurs with smaller meals. Best results are obtained when patients eat solid foods and avoid high calorie liquids and "junk food."

The Lap Band is connected by a thin flexible tube to a small reservoir or port which is placed under the skin and soft tissues of the abdominal wall. This port is accessed by a small needle in order to place more fluid into the band or remove some in order to tighten or loosen the "collar" around the upper part of the stomach.

Patients with the Lap Band system require multiple adjustments in order to be successful. During these adjustments the small port under the skin will be identified. Local anesthesia will be used to numb the area and a thin needle will be inserted into the port to add or remove fluid as indicated to adjust the outlet of the Lap Band. Patients with the Lap Band system should expect a steady, gradual weight loss. When the band is properly adjusted, the weight loss is approximately 1-2 lbs. per week.

Advantages

	The primary advantage of this restrictive procedure is that a reduced amount of well-chewed food enters and passes through the digestive tract in the usual order. That allows nutrients and vitamins to be fully absorbed into the body.
	On average, patients can attain and maintain approximately 40-60% of excess body weight loss.
	The LapBand can be removed and is considered a reversible procedure.
	The Lap Band is adjustable .

Risks

	The LapBand may lead to complications of erosion into the stomach or esophagus, requiring surgical intervention.
	Slippage of the lower portion of the stomach up and through the Band can occur.
	There is a risk of esophageal dysmotility of dilatation
	Because restrictive procedures rely solely on a small stomach pouch to reduce food intake, there is the risk of the pouch stretching.
	Several visits are required to fine-tune the size of the diameter of the band opening and maintian optimal results.
	Some patients lose less than half their excess body weight.
	Leakage of fluid from within the Lap Band apparatus may occur and loosen the collar at the upper stomach, which can lead to weight regain.